People with serious mental illness (SMI) continue to be at high risk for HIV infection. Interventions designed to reduce this risk have been met with only modest success, suggesting a critical need for innovative approaches for this population. The proposed R34 exploratory study grant (a revision of an earlier application) will allow us to adapt and refine two manualized interventions for HIV risk reduction for people with SMI. Our primary aim is to develop a "real world" approach towards reducing HIV risk for this population, integrating recent advances in Motivational Interviewing and traditional Skills-Building interventions. Specifically, we will adapt existing HIV risk reduction Skills Building interventions, which have traditionally been administered in group formats, for use with individual patients. We will then incorporate Motivational Interviewing techniques into the Skills-Building intervention so that we will be able to compare the efficacy of each intervention (Skills-Building alone vs. an integrated Skills-Building and Motivational Interviewing intervention) in order to explore the degree to which integration of Motivational Interviewing techniques augment traditional Skills-Building interventions. Development of these interventions will be a central focus of this project, utilizing focus groups and advisory boards consisting of consumers and providers. Following the development phase of the project, we will pilot-test these interventions with an urban and disenfranchised sample of approximately 40 HIV-seropositive and seronegative men and women with serious mental illness, most of whom will be people of color. Participants will be randomly assigned to a brief, integrated Skills-Building-Motivational Interviewing intervention or to a standard Skills-Building intervention of the same duration and number of sessions. The degree to which these interventions are efficacious in reducing HIV risk behaviors and increasing skills in communication/negotiation and correct condom usage will also be examined. Participant characteristics most likely to predict outcome will also be identified. Another key and unique objective for this project is to examine the degree to which these interventions can be useful in facilitating HIV counseling and testing for people with SMI at risk for HIV. It is our expectation that this intervention refinement and pilot testing will provide us with the data and insight needed for a compelling larger-scale clinical trial, which we will pursue through the R01 mechanism. [unreadable] [unreadable] [unreadable]